Joint instability Flashcards
Hip luxation is often associated with?
Trauma
How is hip luxation diagnosed?
Can be diagnosed on clinical examination when obvious
If not radiography is the imaging modality of choice
What are the two main directions of hip luxation?
- Craniodorsal (most common)
- Trauma
- Dysplasia - Caudoventral
- Abduction of limb (splayed leg)
If a pateint has hip luxation, you should also assess it for which condition, why?
Hip dysplasia
If it does – surgery needed
What are the clinical signs of craniodorsal hip luxation
Internal rotation of the limb
Non weight bearing (often)
Greater trochanter higher than normal
List the 3 palpable landmarks of the hip
3 palpable landmarks – should make a triangle in the normal animal. If there is luxation they can become a straight line
- Ileal wing
- Ischiatic tuberosity
- Greater trochanter
What are the clinical signs of caudoventral hip luxation
Not easy clinically
Greater trochanter lower
Pain ++ (esp CF craniodorsal)
Triangle maybe larger cf contralateral side
Why is it important to know the direction of hip luxation?
Clinical identification is different
Way to reduce is different
Post reduction stabilising techniques
Describe the non-surgical reduction technique for craniodorsal hip luxations
- Needs to be done in first few days
- GA ideal or sedation plus epidural
- Dog in lateral recumbency (affected limb uppermost)
- Towel/ rope around inguinal area (assistant needed)
- Externally rotate the limb to release the femoral head
- Traction caudodistally
- When femoral head distal to dorsal acetabular rim, internally rotate limb
- Immediately radiograph to confirm reduction
When are mandibular physeal separations most commonly seen?
In cats after a fall
How are mandibular physeal separations diagnosed?
Clinical exam:
- Mandibular canines misaligned
- Excess movement
Radiographs:
- Not essential for physeal separation itself
- Needed for other possible fractures
- CT better – day one!!!
How are mandibular physeal separations treated?
Muzzle - Best stabilisation
Wire - Metal, PDS
What are the causes of carpal hyperextension?
- High rise fall (off a wall for example)
- Degeneration (esp. border collies)
- ‘Collateral ligament’ injuries
- Inflammatory arthritis (IMPA)
How is carpal hyperextension diagnosed?
- Clinical exam (compare with other limb but be careful of bilateral injuries)
- Radiographs (including stressed views)
Which factors determine how carpal hyperextension is managed?
- Degree of lameness: if its not lame then you don’t need to do anything
- Dysfunction
- Exercise tolerance
- Load baring of the carpus
When is surgery indicated for carpal hyperextension?
- Partial palmigrade - surgery, splints or nothing
- Palmigrade - surgical
- Traumatic hyperextensions – SURGICAL
How is tarsal instability managed? Based on which factors?
- Degree of lameness
- Dysfunction
- Exercise tolerance
- NOT solely on load bearing angle of tarsus but likely to progress
- Almost certainly SURGICAL
Describe the main features of gastrocnemius enthesopathy
- Large breed dogs
- Thickened Achilles tendon
- Partial or complete plantigrade stance
- Possible crabbed toes
- Almost ALWAYS SURGICAL: do not bandage
Where do digit luxations occur?
Can occur at all three levels
- MTP/C & P1
- P1/P2
- P2/P3
Compare stable and unstable digit luxation management
Determines management
- Unstable luxation at P1/P2 = surgical - Fix or amputation
- Unstable at P2/P3 – slightly different
- Stable: can click back in and bandage
How might you treat P2/P3 luxations?
Ungunal crest ostectomy
Cutting nail short - Need cautery
Describe digit amputation
Only one digit, esp if digit 3 or 4
Through the relevant joint
